Engage patient in the therapeutic relationship. Demonstrate an attitude of respect, patience, and acceptance. Persons who feel cared for, understood, and respected in health care situations are better motivated to collaboratively participate in own care.- Ensure privacy for one-to-one interaction between patient and nurse. Patient's status in relationships with family/loved ones may inhibit frank discussion in their presence. If necessary, move the interaction, modify the environment, or remove others to ensure privacy.
- Avoid limiting choices based on health care provider preference, values, or beliefs and avoid encouraging one choice over another. The health care team is accountable to the patient to provide appropriate information on all available options and to promote autonomous decision-making.
- Ensure that communications and information provided are at a level consistent with the patient's cognitive abilities to ensure understanding.
- Ask patient about understanding of patient's health care need and the available choices to identify any misperceptions.
- Validate patient's understanding to promote self-esteem, confidence in knowledge, and strengthen the therapeutic relationship.
- Accept patient's personal knowledge as relevant to the decision-making process. Discourage patient from discounting personal knowledge and deferring to others' knowledge to promote self-empowerment, confidence, and self-esteem.
Provide education as needed in an accepting, nonjudgmental, supportive manner. Avoid taking a stance of correcting patient; rather, build on patient's knowledge and understanding to build knowledge capacity while preserving self-esteem.- Respectfully inquire as to patient's cultural background, including gender roles, generational roles, and social expectations. Patient is the best source of knowledge of own particular culture.
- Encourage patient to explore any cultural considerations in health care decision-making and to share what it is like for patient to include those considerations. Negative or conflicting emotions, or indecision may arise in the patient due to incongruence between patient's cultural values and beliefs and personal values, beliefs, and preferences.
- Explore with patient the meaning of experiencing making a health care decision. Ask what meaning the current health care situation and having to make a health care decision has for patient. The health care need and necessity to make a health care decision may represent a crisis for the patient. Understanding patient's experience of this can direct the identification of other necessary assessments and interventions.
- Ask patient about strategies used in the past to make decisions. Validate patient's past choices in strategies. Reinforce independent strategies to identify and draw on personal experiences and strengths in decision-making.
- If past experience in decision-making is limited, engage patient to use a problem-solving framework to identify and to evaluate the possible available choices. Ask patient to list the advantages and drawbacks to each choice, as well as personal values, goals, and preferences related to each choice. Encourage patient to identify personal and social barriers to enacting any of the choices. Then ask patient to rate the suitability of each choice based on appraisal of each one. Use of a problem-solving framework in consideration of health care choices encourages patient to consider health care options from the context of own experience and to identify own best choices given the patient's life situation.
Suggested NIC Interventions
Active Listening; Assertiveness Training; Decision-Making Support; Learning Facilitation; Mutual Goal Setting |